I-9 Form

Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer

Last Name (Family Name)*

First Name (Given Name)*

Middle Initial (if any)

Other Last Names Used (if any)

Name

First Name (Given Name)Middle InitialOther Last Names Used (if any)

Address (Street Number and Name)*

Apt. Number

City or Town*

State*

Abbreviated, ex: CA, UT, WA, etc.

ZIP Code*

Date of Birth (mm/dd/yyyy)*

Date

U.S. Social Security Number*

Employee's E mail Address*

example@example.com

Employee's Telephone Number*

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):*

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident4. An alien authorized to work until (fill in expiration date below):

Alien Registration Number/USCIS Number:

Expiration date, if applicable, mm/dd/yyyy:

Some aliens may write "N/A" in the expiration date field if the work authorization does not expire.

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number

2. Form I 94 Admission Number

3a. Foreign Passport Number

3b. Country of Issuance

Signature of Employee*

Today's Date (mm/dd/yyyy)*

Date